Clinical Impact and Cost-Effectiveness of Integrating Infectious Disease Care into Rapid-Access Substance Use Bridge Clinics

About This Grant

PROJECT SUMMARY There are an estimated 3.7 million people who inject drugs (PWID) in the US. They are at high risk for morbidity and mortality from drug overdoses, acute bacterial infections, and complications of chronic viral infections such as HIV and hepatitis C. The syndemic of substance use disorder (SUD) and infections leads to poor health outcomes and high healthcare costs. Bridge clinics are rapid-access, transitional models of SUD care which provide timely initiation of medications for opioid use disorder (MOUD) and treatment for other SUDs. Compared to the traditional model of referral to separate sites for outpatient SUD and infectious disease (ID) care, bridge clinics provide an opportunity to integrate both SUD and ID care and improve outcomes. This project seeks to determine the clinical impact and cost-effectiveness of integrating ID care into bridge clinics to reduce drug overdose and injection-related infections. To achieve this goal, I have two Specific Aims proposed over a 4-year period: 1) to build a longitudinal database of clinical outcomes and healthcare utilization among PWID who receive care in bridge clinics or in standard outpatient care within the largest healthcare system in Massachusetts, and 2) to expand a novel simulation model of injection drug use and assess the cost- effectiveness of bridge clinics compared to standard outpatient SUD care and of integrating ID care into bridge clinics compared to the traditional separate SUD and ID care sites. I am an infectious disease physician and an early-stage clinician-investigator committed to using the methods of decision science to improve care and outcomes for PWID. I seek to leverage my clinical experience in providing care within a bridge clinic and my research experience in simulation modeling and cost-effectiveness analysis to conduct novel research that informs relevant clinical and health policy questions regarding the syndemic of drug use and related infections. To achieve my proposed research aims, I require additional training in 1) database development and observational cohort analysis (skills I will need to derive novel model inputs), and 2) advanced modeling techniques and methods in cost-effectiveness analysis to address model uncertainty. I will accomplish these research and training aims through rigorous methodologic coursework, seminars, and scientific meetings, with support from an accomplished multidisciplinary mentorship team with expertise in simulation modeling and cost-effectiveness analysis (Dr. Andrea Ciaranello), addiction care and policy (Dr. Sarah Wakeman), and database development and observational cohort analysis (Dr. Virginia Triant). The research aims and complementary training plan will set a foundation for becoming an independent investigator advancing methods in decision science and clinical epidemiology at the intersection of drug use and infectious diseases, and for improving access to care and healthcare outcomes for the millions of people who use drugs in the US.